Community management and policy on diabetes patients in coastal developed areas of China: an in-depth analysis of Shanghai model

Diabetes Mellitus is a chronicle disease with a projected growth and social, human and economic consequences that cannot be overlooked in a growing economy and progressively urbanized structure such as China. It is very much a matter of urgency and systemic policymaking. Its insidious nature and everlasting outcomes highlight the importance of preventive measures, focusing on all the contributive factors, such as nutrition, life style, monitoring, diagnosing, and prescription. Aware of this issue, the Chinese Government put forward a reform of the community health service targeting chronic diseases, such as diabetes, at an early stage. However, not all modes of managing the health infrastructure, namely the third tier healthcare system, have been articulated in the same manner and the nature of Chinese economy and society does not allow the direct importation of models in use abroad. Likewise, the primacy of prevention over treatment puts emphasis on the role community-based healthcare play and it should be targeted for a special focus in order to optimize its effectiveness, considering all the complex issues on healthcare of chronic non-infectious diseases. Therefore, with the aim of establishing the theoretic basis to analyze diabetes healthcare management systems this study mobilizes state of art literature from home and abroad, conducts several field studies with multiple stakeholders of the system. This is therefore a macro level study intended to structure knowledge so to depict, explore, understand and offer recommendations to the improvement of the overall community-based diabetes management system in a large coastal urban area in China. To understand the dynamics and possibilities for optimization of the community-based diabetes management the study focused on Shanghai and conducted a comparative empirical study to explore the benefit it brings for the overall purpose of upgrading the system. Likewise, the study endeavored to identify constrains and offer recommendations. Via a mixed methods approach, involving both qualitative techniques and data collection through interviewing key stakeholders (overall 51 interviews conducted) as well as a quantitative approach via a survey with 60 doctors, 60 nurses and 22 patients, and a collection of archival data from 400 patients the study does a comparative analysis to identify to which extent the Shanghai model is superior to the standard one. As an outcome, the study structures a system to improve the effectiveness of community-based diabetes management in China and generates a body of knowledge for future reference and consideration when studying macro-level healthcare systems with a focus on preventable chronic diseases.A Diabetes Mellitus é uma doença crónica com um crescimento estimado e consequências económicas, sociais e humanas que não podem ser negligenciadas numa economia crescente e estrutura progressivamente urbanizada como a China. Trata-se de um assunto com carácter de urgência e de formulação de políticas sistémicas. A sua natureza assintomática a par das consequências duradouras sublinham a importância das medidas preventivas focadas sobre todos os fatores tributários tais como a nutrição, o estilo de vida, a monitorização, diagnóstico e prescrição. Consciente deste problema, o Governo Chinês instituiu uma reforma dos serviços de saúde comunitários centrada nas doenças crónicas em fase inicial, tais como a diabetes. Contudo, nem todos os modos de gestão da infraestrutura de saúde, sobretudo o sistema de três níveis na saúde, tem sido articulado da mesma forma e a natureza da economia e da sociedade chinesas não permite a importação direta dos modelos utilizado internacionalmente. Do mesmo modo a primazia da prevenção sobre o tratamento enfatiza o papel que o sistema de saúde de base comunitária pode desempenhar e, por isso, deve ser alvo de estudo com um foco especial para otimizar a sua eficácia, considerando todos os problemas complexos que as doenças crónicas não infeciosas importam. Assim, com o objetivo de estabelecer as bases teóricas para analisar os sistemas de gestão de saúde, este estudo mobiliza o estado da arte da literatura chinesa e internacional, realiza vários estudos de campo junto de vários stakeholders do sistema. Trata-se de um estudo de nível macro que pretende estruturar o conhecimento de forma a descrever, explorar, compreender e oferecer recomendações conducentes à melhoria global do sistema de saúde comunitário numa grande área urbana costeira na China. Para compreender as dinâmicas e possibilidades de otimização do sistema de gestão de saúde de base comunitária, o estudo centra-se em Shangai e realiza uma análise empírica comparada para explorar as mais-valias que traz para o propósito geral de melhorar o sistema. Do mesmo modo, o estudo procura identificar constrangimentos e oferecer recomendações. Por via de uma abordagem metodológica híbrida, envolvendo quer a recolha de dados e técnicas qualitativas através de entrevistas junto de stakeholders-chave (um total de 51 entrevistas realizadas) bem como uma abordagem quantitativa por via de um inquérito por questionário junto de 60 médicos, 60 enfermeiros, e 22 pacientes, bem como a recolha de dados de arquivo relativos a 400 pacientes, o estudo procede a uma análise comparada para perceber em que medida o modelo de Shangai é superior ao padrão. Como resultado, o estudo estrutura um sistema destinado a melhorar a eficácia dos serviços de saúde de base comunitária na China, com um enfoque na diabetes, e produz um corpo de conhecimentos para referência futura para efeitos de estudos centrados no nível macro dos sistemas de saúde com um foco nas doenças crónicas evitáveis

Proposal and evaluation of online medical services expansion mode for specialties: a patient perceived value perspective

There is a great imbalance and difference in the distribution of Chinese medical resources in urban and rural areas, as most medical resources are concentrated in urban areas. Against the backdrop of China’s promotion of "Internet + medical healthcare", medical institutions are encouraged to apply Internet and other information technologies to expand the space and content of medical services, but patients in remote places lack independent choice of consultation platform. Based on the theory of Maslow's hierarchy of needs, customer perception theory, Synergy theory, TAM and ACSIM, the model building of remote patients' perceived value satisfaction with online medical services for specialties is hypothesized. Take F hospital as the subject, The research provides an empirical research on the process rebuilding and redesigning specialized online health services based on the perceived value of remote patients. To obtain the perceived value needs of remote patients’ visits, this study carries out questionnaire survey to understand the main needs of remote patients visiting. The results show that: social contact and respect value need > safety and survival value need > self-value need > cost losses value. Meanwhile, the preliminary evaluation indicators of patients' perceived value are derived based on the results of the questionnaire. The research is mainly to verify the effect of the implementation of the Internet-based specialized medical partnership medical service access model for remote patients. The post-test questionnaire is designed to understand the overall level of remote patients’ perceived value of online medical services, including the level of perceived ease of use, the level of perceived usefulness, the level of perceived value, the level of satisfaction, and the level of synergy. Among them, the perceived usefulness scores the highest, It is found that the cost of the new model in terms of time, distance, expense, and energy has been significantly reduced. The research, through building the SEM model, tests the path relationships of relevant dimensions and mediating effect of the model of remote patients’ perceived value satisfaction with online medical services for specialties.Verifica-se um grande desequilíbrio na distribuição dos recursos médicos chineses nas áreas urbanas e rurais, visto que a maioria dos recursos médicos está concentrada nas áreas urbanas. No contexto da promoção chinesa de "Internet + saúde médica", as instituições médicas são incentivadas a recorrer à Internet e a outras tecnologias de informação para expandir o espaço e o conteúdo dos serviços médicos, mas os pacientes em lugares remotos não têm escolha independente da plataforma de consulta. Com base na teoria da hierarquia de necessidades de Maslow, teoria da perceção do cliente, teoria da sinergia, TAM e ACSIM, realizou-se a construção do modelo de satisfação do valor percebido de pacientes remotos, com serviços médicos online para especialidades. Considerou-se o hospital F como caso de estudo. A investigação fornece uma pesquisa empírica sobre o processo de reconstrução e redesenho de serviços de saúde online especializados, com base no valor percebido de pacientes remotos. Para obter as necessidades de valor percebido das visitas de pacientes remotos, neste estudo realizou-se uma pesquisa por questionário para entender as principais necessidades das visitas de pacientes remotos. Os resultados mostram que: contato social e respeito valor necessidade e > segurança e valor de sobrevivência necessidade > necessidade de valor próprio > valor de perdas de custo. Enquanto isso, os indicadores de avaliação preliminar do valor percebido dos pacientes são derivados com base nos resultados do questionário. O objetivo principal do presente trabalho é verificar o efeito da implementação do modelo de acesso a serviços médicos especializados, baseada na Internet para pacientes remotos. O questionário pós-teste foi projetado para compreender o nível geral de valor percebido de pacientes remotos de serviços médicos online, incluindo o nível de facilidade de uso percebida, o nível de utilidade percebida, o nível de valor percebido, o nível de satisfação e o nível de sinergia. Entre eles, a utilidade percebida pontua mais alto. Verifica-se que o custo do novo modelo em termos de tempo, distância, despesa e energia foi reduzido significativamente. Por meio da construção do modelo SEM, testaram-se as relações do caminho de dimensões relevantes, e o efeito mediador do modelo de satisfação de valor percebido de pacientes remotos, com serviços médicos online para especialidades

Recent Developments in Smart Healthcare

Medicine is undergoing a sector-wide transformation thanks to the advances in computing and networking technologies. Healthcare is changing from reactive and hospital-centered to preventive and personalized, from disease focused to well-being centered. In essence, the healthcare systems, as well as fundamental medicine research, are becoming smarter. We anticipate significant improvements in areas ranging from molecular genomics and proteomics to decision support for healthcare professionals through big data analytics, to support behavior changes through technology-enabled self-management, and social and motivational support. Furthermore, with smart technologies, healthcare delivery could also be made more efficient, higher quality, and lower cost. In this special issue, we received a total 45 submissions and accepted 19 outstanding papers that roughly span across several interesting topics on smart healthcare, including public health, health information technology (Health IT), and smart medicine

Discrete Event Simulations

Considered by many authors as a technique for modelling stochastic, dynamic and discretely evolving systems, this technique has gained widespread acceptance among the practitioners who want to represent and improve complex systems. Since DES is a technique applied in incredibly different areas, this book reflects many different points of view about DES, thus, all authors describe how it is understood and applied within their context of work, providing an extensive understanding of what DES is. It can be said that the name of the book itself reflects the plurality that these points of view represent. The book embraces a number of topics covering theory, methods and applications to a wide range of sectors and problem areas that have been categorised into five groups. As well as the previously explained variety of points of view concerning DES, there is one additional thing to remark about this book: its richness when talking about actual data or actual data based analysis. When most academic areas are lacking application cases, roughly the half part of the chapters included in this book deal with actual problems or at least are based on actual data. Thus, the editor firmly believes that this book will be interesting for both beginners and practitioners in the area of DES

Construction of Adverse Events Monitoring View for People Living with HIV Based on AIDS Database

Background Acquired immunodeficiency syndrome (AIDS), is a global malignant infectious disease with extremely high fatality rate caused by human immunodeficiency virus (HIV). Regarding there is still no AIDS vaccine or cure in the world so far, the usage of Highly Active Anti-Retroviral Therapy (HAART) is currently the most effective way to suppress viral replication and also the basic therapy. However, drug resistance and different degrees of adverse events (AE) on PLWHIV could occur and cause major impact on health and quality of life for PLWHIV. Therefore, continuous monitoring and assessment of AE play a key role for PLWHIV. At present, decentralized clinical data are suggested to be a major problem during AE monitoring process, thus digital unified view of AE monitoring is asked for badly from health professionals to simplify the tedious process of clinical data collection. However, current domestic and foreign research still lacks a unified view of AIDS-specific clinical information. Therefore, this study intends to design and construct an AE Monitoring View for PLWHIV who receive HAART based on AIDS database, through which clinicians and nurses are able to be assisted in clinical decision-making, nursing diagnosis as well as timely corresponding intervention measures. Objectives The Overall objective is to construct an AE Monitoring View for PLWHIV. There are 3 specific objectives, which are demonstrated respectively: (1) To explore the demand of AE Monitoring View for PLWHIV among clinicians and nurses, (2) To construct the framework of AE Monitoring View for PLWHIV, (3) To develop and perform functional tests on the implemented functions. Methods The research was comprised of 3 parts: Part 1: The demand exploration of AE Monitoring View for PLWHIV among clinicians and nurses The researcher conducted semi-structured interviews to learn about current monitoring process of AE for PLWHIV, current common and rare AE and interventions on AE for PLWHIV, current problems clinicians and nurses would meet with during AE monitoring process, and their usage requirements on AE Monitoring View. Part 2: The construction of the framework on AE Monitoring View for PLWHIV The researcher established a research team with clinicians and nurses and technicians to discuss about the framework and drafted a first version based on relevant literature, drug instructions, Common Terminology Criteria for Adverse Events (CTCAE), and interview results. The researchers then sent the version to 14 experts for expert argumentation, until all experts agreed and the final framework version was finalized and moved to the next stage. Part 3: Testing and application of AE Monitoring View for PLWHIV Based on the final version of framework previously developed for AE Monitoring View, the researcher developed and internally tested the view in collaboration with technicians from a medical technology company, which the researcher then handed over to the research team with a questionnaire investigated later to conduct internal feasibility pilot-test for usability evaluation. This view is yet unmature and will be put into use after the AIDS Database is fully constructed in the future. Results Part 1: The demand exploration of AE Monitoring View for PLWHIV among clinicians and nurses Based on the interview results of 11 clinicians and nurses, the researcher learned about the most common clinical AE in AIDS patients and their monitoring status. In addition, the researcher also summarized the current clinical workers' requirements for electronic information systems on monitoring process of AE. The demand exploration shows: 1) Current AE monitoring process, including patient self-reports and regular patient review, 2) Common and rare AE for PLWHIV, such as rash, neurological symptoms, gastrointestinal disorders and so on, 3) Common interventions from clinicians and nurses on AE for PLWHIV, for instance, continuous monitoring, conventional conservative treatment and replacement of drug regimen， 4) The problems of current AE monitoring process, including continuity and accuracy, 5) Requirements on AE Monitoring View for PLWHIV, like visualization tool, list of AE with manifestations and interventions. Part 2: The construction of the framework on AE Monitoring View for PLWHIV The researcher established a research team of 11 members for frame design and content construction on AE Monitoring View for PLWHIV. After literature study and discussion, the researcher drafted out the preliminary framework of AE Monitoring View for PLWHIV. Meanwhile, through two rounds of Delphi expert consultation methods and collected expert opinions, the researcher optimized and improved the content of framework, and determined the final version of framework for AE Monitoring View, including 5 levels, which was drug name, system AE belongs to, specific AE, manifestations and corresponding interventions. According to the opinions of experts, the researcher finally deleted the items such as “allergic reaction”, “acidosis”, “hypophosphatemia”, etc., and added items such as “inattention” and “lactic acidosis”. At the same time, according to the specificity of AIDS and the uniqueness of AE caused by antiviral drugs, the researcher modified and improved the symptoms and corresponding interventions in a targeted manner. For example, most somatic symptoms such as dizziness and headache are mild Symptoms, which do not require intervention, will gradually improve after taking the drug for a period of time. These are slightly different from those described in the CTCAE, thus the researcher has made modifications based on the recommendations made by experts. Part 3: Testing and application of AE Monitoring View for PLWHIV The researcher presented the final version over the content framework of the AE Monitoring View for PLWHIV to technicians and collaborated on the development of the Monitoring View, which was internally functionally tested. The actual results were consistent with the expected results, and the research team subsequently conducted a pre-test usability evaluation of the Monitoring View, which indicated a high usability of the AE Monitoring View for PLWHIV. Conclusions (1) The current state of AE monitoring process and the demands of clinicians and nurses for an AE Monitoring View for PLWHIV were investigated through qualitative interviews, (2) Based on AIDS database, the content framework of the AE Monitoring View for PLWHIV was determined through two rounds of Delphi expert consultations based on the existing literature and CTCAE criteria as a guideline, (3) The researcher and the technicians from the medical technology company cooperated to develop and internally test the AE Monitoring View for PLWHIV. After the AIDS Database is successfully built, it will be released to public together.Tausta Immuunikato, Acquired immunodeficiency syndrome (AIDS), on maailmanlaajuinen pahanlaatuinen tartuntatauti, jolla on erittäin korkeat luvut kuolemantapauksien suhteen, jotka aiheuttavat HI-virus. Maailmassa ei ole vielä AIDS-rokotetta tai parannuskeinoa, mutta Highly Active Anti-Retroviral Therapy (HAART) käyttö on tällä hetkellä tehokkain tapa tukahduttaa viruksen replikaatio. HIV-potilailla voi kuitenkin esiintyä lääkeresistenssiä ja erilaisia haittavaikutuksia ja ne voivat aiheuttaa merkittäviä vaikutuksia HIV-potilaiden terveyteen ja elämänlaatuun. Tästä syystä haittatapahtumien jatkuva seuranta ja arviointi ovat avainasemassa HIV-potilailla. Nykyään, suurin ongelma haittatapahtumien seurannassa on ehdotettu olevan hajallaan olevat kliiniset tiedot. Siksi olisikin tärkeää yksinkertaistaa kliinisten tietojen keräämistä. Nykyisestä kansallisesta ja ulkomaisesta tutkimuksesta puuttuu kuitenkin edelleen yhtenäinen näkemys AIDS-spesifisestä kliinisestä tiedosta. Siksi tämän tutkimuksen tarkoituksena on suunnitella ja rakentaa haittatapahtumien seurantajärjestelmä HIV-potilaille, jotka saavat HAART-hoitoa. Haittatapahtumien seurantajärjestelmän avulla voidaan auttaa lääkäreitä ja sairaanhoitajia kliinisessä päätöksenteossa, hoitotyön diagnoosien tekemisessä sekä oikea-aikaisten hoitotoimenpiteiden valinnassa. Tavoitteet Tavoitteena on rakentaa haittatapahtumien seurantajärjestelmä HIV-potilaille. Tutkielmassa on kolme osatavoitetta: (1) Tutkia HIV-potilaiden haittatapahtumien seurantajärjestelmän tarvetta lääkäreiden ja hoitajien näkökulmasta (2) Rakentaa HIV-potilaiden haittatapahtumien seurantajärjestelmälle viitekehys (3) Kehittää ja suorittaa toiminnallisia testejä haittatapahtumien seurantajärjestelmälle Metodit Tutkimus toteutettiin kolmessa eri vaiheessa: Vaihe 1: Tarve HIV-potilaiden haittatapahtumien seurantajärjestelmälle lääkäreiden ja sairaanhoitajien näkökulmasta Tutkija suoritti puolistrukturoidut haastattelut oppiakseen HIV-potilaiden tämänhetkisestä haittatapahtumien seurannasta, oppiakseen HIV-potilaiden yleisistä ja harvinaisista haittatapahtumista, selvittääkseen, mitkä ovat nykyisiä ongelmia haittatapahtumien seurannassa, joita lääkärit ja sairaanhoitajat kohtaavat sekä selvittääkseen millaisia vaatimuksia lääkäreillä ja sairaanhoitajilla olisi haittatapahtumien seurantajärjestelmälle. Vaihe 2: HIV-potilaiden haittatapahtumien seurantajärjestelmän viitekehyksen rakentaminen Tutkija perusti tutkimusryhmän lääkäreiden, sairaanhoitajien ja teknikkojen kanssa keskustellakseen viitekehyksestä ja laati ensimmäiseen version, joka perustui kirjallisuuteen, lääkeohjeisiin, Common Terminology Criteria for Adverse Events (CTCAE) -kriteereihin ja haastattelun tuloksiin. Sen jälkeen ensimmäinen versio haittatapahtumien seurantajärjestelmästä lähetettiin 14 asiantuntijalle arvioitavaksi. Kunnes kaikki asiantuntijat olivat yhtä mieltä, lopullinen versio viimeisteltiin ja siirryttiin seuraavaan vaiheeseen. Vaihe 3: HIV-potilaiden haittavaikutusten seurantajärjestelmän testaus ja soveltaminen Tutkija kehitti ja testasi edellisessä vaiheessa kehitettyä lopullista versiota haittavaikutusten seurantajärjestelmästä yhteistyössä lääketieteellisen teknologian yrityksen teknikoiden kanssa. Tämän jälkeen tutkimusryhmän jäsenet arvioivat seurantajärjestelmän kyselylomakkeen avulla. Käytettävyyskyselyn tuloksia hyödynnetään tulevaisuudessa, kun AIDS-tietokantaa kehitetään edelleen. Tulokset Vaihe 1: Tarve HIV-potilaiden haittavaikutusten seurantajärjestelmälle lääkäreiden ja sairaanhoitajien näkökulmasta Haastattelun tulosten perusteella (n=11 lääkäriä ja sairaanhoitajaa) tutkija oppi, mitkä ovat AIDS-potilaiden yleisimpiä kliinisiä haittavaikutuksia ja miten niitä seurataan. Lisäksi tutkija kokosi kliinisten työntekijöiden tarpeet ja vaatimukset elektroniseen haittavaikutusten seurantajärjestelmään liittyen. Tulokset osoittavat: 1) Haittavaikutusten nykyisen seurantaprosessin, mukaan lukien potilaan itseraportit ja säännöllinen potilasarviointi, 2) Yleiset ja harvinaiset haittavaikutukset kuten ihottuman, neurologiset oireet, ruoansulatuskanavan oireet 3) Yleiset hoitokeinot, kuten jatkuva seuranta, tavanomainen konservatiivinen hoito ja lääkehoidon korvaaminen 4) Ongelmat nykyisessä seurantajärjestelmässä, kuten ongelmat jatkuvuudessa ja tarkkuudessa 5) Vaatimukset HIV-potilaiden haittavaikutusten seurantaohjelmalle, kuten visualisointityökalu, luettelo haittavaikutuksista ja niiden hoitokeinoista Vaihe 2: HIV-potilaiden haittatapahtumien seurantajärjestelmän viitekehyksen rakentaminen Tutkija perusti 11 henkilön tutkimusryhmän haittavaikutusten seurantajärjestelmän viitekehyksen suunnittelemiseksi ja sisällön rakentamiseksi. Kirjallisuuteen tutustumisen jälkeen, tutkija teki ensimmäisen luonnoksen. Kahden Delphi-asiantuntijapaneelin konsultointikierroksen jälkeen tutkija kehitti ensimmäistä versiota palautteiden perusteella ja lopulta haittavaikutusten seurantajärjestelmän luonnos koostui viidestä eri tasosta, mitkä olivat: lääkkeen nimi, haittavaikutuksen kategoria, haittavaikutus, ilmenemismuodot ja hoitotoimenpiteet. Asiantuntijoiden palautteiden mukaan tutkija poisti lopulta nimikkeet, kuten ”allerginen reaktio”, ”asidoosi”, ”hypofosfatemia” ja lisäsi nimikkeitä, kuten ”tarkkaamattomuus” ja ”maitohappoasidoosi”. Samaan aikaan AIDS:n spesifisyyden ja epävirallisten lääkkeiden aiheuttamien haittavaikutusten ainutlaatuisuuden vuoksi, tutkija muutti ja paransi oireiden ja hoitotoimenpiteiden nimikkeitä kohdennetusti. Esimerkiksi useimmat somaattiset oireet, kuten huimaus ja päänsärky, ovat lieviä oireita, jotka eivät vaadi hoitotoimenpiteitä, paranevat vähitellen lääkkeen ottamisen jälkeen jonkin aikaa. Nämä ovat hieman erilaisia kuin CTCAE:ssä kuvatut, joten tutkija on tehnyt muutoksia asiantuntijoiden suositusten perusteella. Vaihe 3: HIV-potilaiden haittavaikutusten seurantajärjestelmän testaus ja soveltaminen Tutkija esitteli teknikoille lopullisen version HIV-potilaiden haittavaikutusten seurantajärjestelmän sisältökehyksestä ja teki yhteistyötä seurantajärjestelmän kehittämisessä, joka testattiin ryhmän sisäisesti. Tulokset olivat yhdenmukaisia odotettujen tulosten kanssa, ja tutkimusryhmä teki vielä myöhemmin seurantajärjestelmän käytettävyystestauksen, joka osoitti, että HIV-potilaiden haittavaikutusten seurantajärjestelmän käytettävyys on korkealla tasolla. Johtopäätökset (1) Haittavaikutusten seurantajärjestelmän nykytilaa sekä lääkäreiden ja sairaanhoitajien vaatimuksia seurantajärjestelmään liittyen tutkittiin laadullisten haastattelujen avulla, (2) AIDS-tietokannan perusteella haittavaikutusten seurantajärjestelmän sisältökehys määritettiin kahdella Delphin asiantuntijakuulemiskierroksella, jotka perustuivat olemassa olevaan kirjallisuuteen ja CTCAE:n kriteereihin, (3) Tutkija ja lääketieteellisen teknologiayrityksen teknikot yhteistyössä kehittivät ja testasivat HIV-potilaiden haittavaikutusten seurantajärjestelmän. Kun AIDS-tietokanta on rakennettu onnistuneesti, se julkaistaan laajemmalle yleisölle

Data Science in Healthcare

Data science is an interdisciplinary field that applies numerous techniques, such as machine learning, neural networks, and deep learning, to create value based on extracting knowledge and insights from available data. Advances in data science have a significant impact on healthcare. While advances in the sharing of medical information result in better and earlier diagnoses as well as more patient-tailored treatments, information management is also affected by trends such as increased patient centricity (with shared decision making), self-care (e.g., using wearables), and integrated care delivery. The delivery of health services is being revolutionized through the sharing and integration of health data across organizational boundaries. Via data science, researchers can deliver new approaches to merge, analyze, and process complex data and gain more actionable insights, understanding, and knowledge at the individual and population levels. This Special Issue focuses on how data science is used in healthcare (e.g., through predictive modeling) and on related topics, such as data sharing and data management

Adaptation of domestic state governance to international governance models

The purpose of the article is to provide the evolving international trends of modern management models and authorial vision of model of state governance system in Ukraine, its subsystems, in particular, the system of provision of administrative services that is appropriate for the contemporary times. Methodology. On the basis of scientific and theoretical approaches to the definitions of terms “state governance” and “public governance”, there was an explanation of considerable difference between them and, taking into consideration, the mentality of Ukrainian society and peculiar weak side in self-organization, the authors offered to form authorial model of governance on the basis of historically traditional for Ukraine model of state governance and to add some elements of management concepts that proved their significance, efficiency and priority in practice. Results. The authors emphasized the following two prevailing modern management models in the international practice: “new state management” and “good governance”. The first concept offered for consideration served as a basis for the semantic content of state activity that reflects more the state of administrative reformation. Practical meaning. A practical introduction of management to the domestic model of governance creates the range of contradictions that do not allow implementing herein concept. Pursuant to authors, the second one allows in considerable measure to reform state governance, considering historically developed peculiarities of this model. Moreover, the involvement of concept herein into introduction of informational and communicational technologies in the process of governance eliminates the necessity of power decentralization, it allows to form real net structure and, at the same, to keep vertical power structure, to involve citizens for formation and taking of management decisions, to form electronic communicational channel of feedback, to provide citizens with electronic administrative services. All indicated advantages of the concept certify about the necessity to reform state governance exactly in this field. Meaning/ Distinction. This article raises a question about the significance of formation and sequence of state policy in Ukraine aimed at creating an information-oriented society, space, as well as informational and technological infrastructure

Net structure of subject-to-subject relations in the management of the system of administrative services provision

The purpose of the work is to form the net structure of management of the system of administrative services provision on the basis of implementation of subject-to-subject interactions between state sector and civil society. Methodology. The methodology basis for the investigation is the abstract-logical analysis of theoretical and methodological backgrounds for management of relations and interactions. For the theoretical generalization and formation of net structure, there are used scientific recommendations of Ukrainian scientists regarding the necessity to implement subject-to-subject relations in the system of administrative services provision. Results. The investigations allowed confirming that the hierarchical structure of the state governance system does not give an opportunity to implement equal interaction between a subject of provision and a subject of an appeal as these relations have one – way communication and the feedback channel has a formal character. Moreover, the civil society is not considered by state sector to be a source of methods and ways to develop the system of state governance, in particular, the management system of administrative services provision. Practical meaning. The net structure of management will allow implementing the subject-subject relations in the system, under which the actions of the subject of provision – that means state sector – will be directed to the realization of rights and interests of the subjects of appeal. In their turn, apart from the performance of all legislative responsibilities that they should perform, they can carry out activities directed to the development of management activity in the system of administrative services provision and the whole system of state governance as an integral system of management. Meaning/Distinction. The provided model of the net structure will allow involving citizens in the processes of state governance and increasing the impact of the civil sector during the making of state and management decisions and, as a result, to confirm subject-to-subject positions in the relations

Scheduling Allocation and Inventory Replenishment Problems Under Uncertainty: Applications in Managing Electric Vehicle and Drone Battery Swap Stations

In this dissertation, motivated by electric vehicle (EV) and drone application growth, we propose novel optimization problems and solution techniques for managing the operations at EV and drone battery swap stations. In Chapter 2, we introduce a novel class of stochastic scheduling allocation and inventory replenishment problems (SAIRP), which determines the recharging, discharging, and replacement decisions at a swap station over time to maximize the expected total profit. We use Markov Decision Process (MDP) to model SAIRPs facing uncertain demands, varying costs, and battery degradation. Considering battery degradation is crucial as it relaxes the assumption that charging/discharging batteries do not deteriorate their quality (capacity). Besides, it ensures customers receive high-quality batteries as we prevent recharging/discharging and swapping when the average capacity of batteries is lower than a predefined threshold. Our MDP has high complexity and dimensions regarding the state space, action space, and transition probabilities; therefore, we can not provide the optimal decision rules (exact solutions) for SAIRPs of increasing size. Thus, we propose high-quality approximate solutions, heuristic and reinforcement learning (RL) methods, for stochastic SAIRPs that provide near-optimal policies for the stations. In Chapter 3, we explore the structure and theoretical findings related to the optimal solution of SAIRP. Notably, we prove the monotonicity properties to develop fast and intelligent algorithms to provide approximate solutions and overcome the curses of dimensionality. We show the existence of monotone optimal decision rules when there is an upper bound on the number of batteries replaced in each period. We demonstrate the monotone structure for the MDP value function when considering the first, second, and both dimensions of the state. We utilize data analytics and regression techniques to provide an intelligent initialization for our monotone approximate dynamic programming (ADP) algorithm. Finally, we provide insights from solving realistic-sized SAIRPs. In Chapter 4, we consider the problem of optimizing the distribution operations of a hub using drones to deliver medical supplies to different geographic regions. Drones are an innovative method with many benefits including low-contact delivery thereby reducing the spread of pandemic and vaccine-preventable diseases. While we focus on medical supply delivery for this work, it is applicable to drone delivery for many other applications, including food, postal items, and e-commerce delivery. In this chapter, our goal is to address drone delivery challenges by optimizing the distribution operations at a drone hub that dispatch drones to different geographic locations generating stochastic demands for medical supplies. By considering different geographic locations, we consider different classes of demand that require different flight ranges, which is directly related to the amount of charge held in a drone battery. We classify the stochastic demands based on their distance from the drone hub, use a Markov decision process to model the problem, and perform computational tests using realistic data representing a prominent drone delivery company. We solve the problem using a reinforcement learning method and show its high performance compared with the exact solution found using dynamic programming. Finally, we analyze the results and provide insights for managing the drone hub operations

Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-